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A model to predict motor performance in preterm infants at 5 years
Anjo J W M Janssen1, Maria W G Nijhuis-van der Sanden, Reinier P Akkermans
1Radboud University Nijmegen Medical Centre, Department of Pediatric Physical Therapy, Nijmegen, The Netherlands. a.janssen@cukz.umcn.nl
Insights
A new prediction model accurately identifies preterm infants likely to have normal motor development at age 5. This approach can improve follow-up efficiency, reducing unnecessary assessments for many children.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Motor development assessment
Background:
- Routine motor assessments at 5 years are often unnecessary for preterm infants, as ~60% show normal development.
- Inefficiency in current follow-up practices for preterm infant motor assessment.
Purpose of the Study:
- Develop a predictive model for 5-year motor performance in preterm infants.
- Achieve a sensitivity of at least 90% for accurate prediction.
- Enhance the efficiency of follow-up protocols for preterm infants.
Main Methods:
- Longitudinal study design including 371 preterm infants (gestational age ≤32 weeks), excluding those with severe disabilities.
- Used Movement Assessment Battery for Children (M-ABC) at 5 years as the dependent variable (delayed motor performance <15th percentile).
- Included 20 neonatal risk factors, maternal education, and Bayley Scales of Infant Development (2nd ed.) at 2.5 years as predictors.
Main Results:
- A predictive model developed using binary logistic regression achieved 94% sensitivity.
- Key predictors included: Motor Scale PDI <90, Behavior Rating Scale (BRS) motor quality <26th percentile, gestational age <30 weeks, male gender, and intra-ventricular hemorrhage.
- The model was validated on 345 infants.
Conclusions:
- The developed prediction model significantly enhances follow-up efficiency by 37%.
- Implementing the model would avoid assessments for 129 children while correctly identifying those needing intervention.
- This model offers a more targeted approach to motor assessment for preterm infants.
Background:
Approximately 60% of preterm infants who are assessed at 5 years for motor performance in a standardized multidisciplinary follow-up program are found to have normal results, indicating that, for these children, routine motor assessment at this age is unnecessary.
Aim:
To improve the efficiency of our follow-up practice for motor assessment by developing a model to predict motor performance of preterm infants at 5 years with a maximal sensitivity (>or=90%).
Study Design:
Longitudinal design.
Subjects:
We included preterm infants (n=371) with a gestational age of
Outcome Measures:
The Movement Assessment Battery for Children (M-ABC) at 5 years with 'delayed' motor performance (<15 percentile) was the dependent variable. As factors in the model, we used twenty neonatal risk factors, the maternal education level, the Motor Scale and the Behavior Rating Scale (BRS) of the Bayley Scales of Infant Development, 2nd edition, at 2(1/2) years.
Results:
Binary logistic regression analysis revealed that the prediction model (n=345) reached a sensitivity of 94%. Five factors contributed significantly (p<0.05) to the model: a Motor Scale PDI <90 and a BRS 'motor quality' <26 percentile, and the neonatal risk factors gestational age <30 weeks, male gender and intra-ventricular hemorrhage.
Conclusion:
The prediction model can improve the efficiency of follow-up practice for motor assessment by 37% at 5 years. Applying this model, we would not have assessed 129 children and would have missed six children.
